The Effect of Financial Incentives on Utilization of Low-cost Providers
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|ClinicalTrials.gov Identifier: NCT02249156|
Recruitment Status : Active, not recruiting
First Posted : September 25, 2014
Last Update Posted : March 7, 2017
Harvard Medical School
University of Southern California
University of California, Berkeley
Information provided by (Responsible Party):
Ateev Mehrotra, Harvard Medical School
Several employers in the US have introduced a program where their employees receive a financial incentive to receive lower cost care. Under this "Rewards" program, patients are free to choose providers but if they visit a pre-determined low-cost laboratory or radiology facility (called a "rewards provider"), they receive a financial incentive. The financial incentive is typically in the form of a Health Savings Account (HSA) contribution. The dollar amount varies by employer. This study will use medical claims data to examine if this program leads to an increase in the volume of services performed by low-cost providers and decreased health care spending.
|Condition or disease||Intervention/treatment|
|Receipt of Radiology Studies Receipt of Laboratory Tests||Behavioral: Financial incentive for choosing a lower-cost provider|
Show Detailed Description
|Study Type :||Observational|
|Estimated Enrollment :||884000 participants|
|Official Title:||The Effect of Financial Incentives on Utilization of Low-cost Providers|
|Study Start Date :||August 2014|
|Estimated Primary Completion Date :||December 2017|
|Estimated Study Completion Date :||March 2018|
Financial incentive group
Employees of employers who have introduced the Rewards program. Currently there are two employers who have introduced the Rewards program, but there might be others that introduce it in the coming months. All intervention (and control) employers are customers of Castlight and use their price transparency product.
Behavioral: Financial incentive for choosing a lower-cost provider
Employees of the intervention group receive money (either as a payment to their health savings account or directly as a check) if they obtain a radiology test or laboratory test from what a low-cost or rewards provider. The amount of money per test varies by the employer and type of test. A provider is identified as low-cost or rewards if their costs are in the lowest 10-20% among all providers in the community. Again there is a range because the relative cutoff has varied across the employers that have implemented this program.
Large employers who have not introduced the Rewards program, but work with Castlight and use their transparency product. It will be ideal if the control population looks similar to the intervention population in key characteristics - age, level of illness, industry of the employer (for example, manufacturing), pre-intervention spending, and geographic distribution. If possible, across a pool of potential control employers, we will identify control employers that look the most similar across these characteristics in the pre-intervention period. Another possible strategy we might use is to weight the individuals in the control population in our analyses by how similar they appear to those in the intervention population.
Primary Outcome Measures :
- Service volume [ Time Frame: In 12 months after intervention initiated ]Service volume for each provider-employer before and after the introduction of the rewards programs. We will estimate models with several potential measures of volume including the number of services performed, the number of unique patients seen by the provider, and the fraction of all services received by the employees.
Secondary Outcome Measures :
- Total spending [ Time Frame: In 12 months after intervention initiated ]Total spending on laboratory and imaging services
- Utilization of laboratory and imaging services [ Time Frame: In 12 months after intervention initiated ]
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